itn fafrarn site fernra wrferercot i Giicn INSURANCE REGULATORY AND indlea DEVELOPMENT AUTHORITY CIRCULAR Ref: IRDAVHLT/MISC/CIR/209/09/2011 September 9 2011 VO ALL NON LIFE INSURERS Re: Health Insurance Portability The IRDA, vide circular dated February 10, 2011, had issued guidelines on portability of health insurance policies which was to be introduced from 1" July 2011. Subsequently, on 24" June 2011, it was felt necessary to put in place a system to cnable collection of data on the history of health insurance and monitoring the transfer of records of the porting policy holder. In that context, it was decided that the implementation of portability of health insurance policies would be mandated to commence no later than 1" October 2011. In continuation of the above guidelines, the detailed procedure on health insurance portability shall be as set out in these guidelines. In these guidelines, the following terms shall carry the meanings as assigned to them 1.1 Portability: Portability means the right accorded to an individual health insurance policyholder (including family cover) to transfer the credit gained by the insured for pre-existing conditions and time bound exclusions if the policyholder chooses to switch from one insurer to another insurer or from one plan to another plan of the same insurer, provided the previous policy has been maintained without any break 1.2 Break in policy: A break in policy occurs when the premium due on a given policy is not paid on or before the premium renewal date or within 30 days, thereof 1 cftara wera, te ar, wate ay, eer ~ 500004. HEA Parshram Bhavan, Sr Foor, Basheer Bagh, Hyderabad- 500 O08. nda D : 91-040-2598 1100, 75 : 93-00-6682 9334 Ph. 81-040-2338 1100, Fax 91-040.6682 3034 $7: irda @ieéagocin 2: wird. gorin/ wend org E-mail rda@ica.govin Web. wwwitde.govin / wim dena. orgINSURANCE REGULATORY AND hides DEVELOPMENT AUTHORITY 2. All policyholders are hereby vested with the right of portability, ie. policyholders have the right to purchase a Health Insurance Policy from another insurer from amongst the ned products suel insurer is marketing and the right will be limited to transfer of the period in the existing policy (ies) which would account towards PEDs and the time-bound exclusions of the new policy 3. A policyholder desirous of porting his policy to anather insurance company shall apply to such insurance company at least 45 days before the premium renewal date of his‘her existing poliey 3.1. The Insurer may not be liable to offer portability if policyholder fails 10 approach the new insurer at least 45 days before the premium renewal date, 3.2. ‘The insurer may consider a proposal for portability even if the policyholder fails to approach the insurer at least 45 di s belore the renewal date, it may be free to do so. 3.3. Where the outcome of acceptance of portability is still waiting from the new insurer on the date of renewal 3.3.1 the existing policy shall be allowed (o extend, if requested by the policyholder, for the short period by accepting a pro- rate premium for such short period, which shall be of at feast one month and. 3.3.2shall not cancel existing policy until such time a confirmed policy from new insurer is received or at the specific written request of the insured 3.3.3the new insurer, in all such cases, shall reckon the date of the commencement of risk to match with date of expiry of the short period, wherever relevant 2 ftom ver, den ae atta, tee - soo ooa, TT atetram Bovan, Foe, Base’ Bagh, Hjcrabed- 50004. Inca ©: o-040 290 1100, : 1-040.6582 9508 Ph: 91-060-2898 100, Fox: 91-40 90828338 E57: irda@irdagovin FA: wweniaa.gouin | wewirsinga.org E-mail :idaia.govin Web. wmmirda.gouin /wwitdainciaorgaint fatten ait farcare wrfrercot INSURANCE REGULATORY AND vides. DEVELOPMENT AUTHORITY 3.3.4if for any reason the insured intends to continue the policy further with the existing insurer, it shall be allowed to continue by charging a regular premium and without imposing any new condition. 4. On receipt of an application for porting, the insurance company shall furnish the applicant, the Portability Form as set out in Annexure “A” to these guidelines together with a proposal form and relevant product literature on the various health insurance products which could be offered. 5 The policyholder shall fill in the portability form along with proposal form and submit the same to the insurance company 6. On receipt of the Portability Form, the insurance company shall address the existing insurance company seeking necessary details of medical history and claim history of the concemed policyholder. This shall be done through the web portal of the IRDA within 7 working days of the receipt of the Portability form. 7. ‘The insurance company receiving from another insurance company @ request for relevant data shall furnish the requisite data in the data format for porting insurance policies prescribed in the web portal of IRDA within 7 working days of the receipt of the request 8. On receipt of the data from the existing insuranee company, the new insurance company may underwrite the proposal in accordance with its underwriting policy as filed by the company with the Authority in accordance with clause 6 of IRDA Form R2 of IRDA ons, 2000 and clause 14-15 of F&L (Registration of Indian Insurance Companies) Regulat Guidelines (circular no. 021/IRDA/F&U/Sep. 06 dated 28" September 2006), and convey its ecision to the policyholder in accordance with the Regulation 4 (6) of the IRDA (Protection of Policyholders’ interest) Regulations, 2002 3 ‘oft ore, ster ar, avin am, BTA ~ 500 008. STE Patshram Bravan, Sd Foor, Bashoer Bach, Hyderabad - 800 OD. India © :91-040-2598 1100, fo: 91-040-6682 9334 Ph, 81-040-2968 110, Fax 91-040-6682 3398 $57: eda@roa.govin 7: wawiedagovin / warwirdainc.org E-mail rda@ica.govia Web. : wwwikde-govin / wn tcandia. org